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Human Circadian Pacemaker Regulation of circadian period in humans was thought to differ from that of other species, with the period of the activity rhythm… median 25.2 hours… in adulthood, and to shorten with age. Now revealed that the intrinsic period of the human circadian pacemaker averages 24.18 hours in both age groups, with a tight distribution consistent with other species. Czeisler CA et al Science 1999

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What is EEG? In EEG recording, the simultaneous activities of many cortical neurons are measured by extracellular macroelectrodes

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Origin of EEG When thousands of neurons are excited simultaneously, the tiny signal from each cell sum up to generate one large surface signal. Asynchronous activity, on the other hand, produce irregular signals

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Excessive Daytime Sleepiness (EDS) Sleepiness that occurs at inappropriate or undesirable times or that interferes with daytime activities is general considered excessive by patients & clinicians Aldrich MS., 1999

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EDS Sleepiness is pervasive in modern society EDS is a frequent symptom that has many possible causes Prevalence rates of EDS may vary from 0.3% - 13.3% (Schmidt-Nowara et al., 1991)

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EDS – Common Causes Young adults: their quantity of sleep is insufficient as a result of poor sleep hygiene Elderly people: their quality of sleep is poor Shift workers: repeated violations of the circadian rhythm Others: they fall within the realm of pathology, whether primary, as in the intrinsic disorders of sleep, or secondary to a psychiatric, neurologic, or medical condition

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Sleep Disorders in Children 25 % of children experience some type of sleep disturbance Sleep problems may be associated with difficult temperament in children. Instead of appearing sleepy, the overtired child may appear overactive & inattentive. Wake up America, A National Sleep Alert January, 1993

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Consequence of sleep disorders Sleep disturbance can produce a range of cognitive impairments such as memory, attention, visuospatial abilities and creativity as well In general population, poor academic performance was associated with sleep deprivation Serious psychosocial problems (including alcohol and drug abuse) have been described as a consequence of sleep disturbance in adolescents Stores G 1999

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Sleepwalking: Definition SLEEPWALKING consists of a series of complex behaviors that are initiated during slow wave sleep and result in walking during sleep.

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Sleepwalking: Incidence/Prevalence Between 1 and 15% of the general population. Most western studies reported 10-20% of healthy children have had at least one episode of sleepwalking. Above the age of 15 years, the incidence of sleepwalking is 1%. Equal distribution in both sexes.

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Chronic insomnia & school performance Insomnia was the most powerful predictor of school failure, more significant than parental education and profession. The rate of school failure among insomniacs was twice that of non- insomniacs Sleep Research 1990;19:1

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Summary of local data Sleep duration decreases across age Students tend to compensate their sleep during weekend which may suggest that they might be sleep deprived during school days Difficulty to fall asleep was the most common problems among HK adolescents

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Conclusion Sleep deprivation was prevalent among Hong Kong medical students Sleep deprived students had significantly shorter weekday sleep hours but similar weekend sleep time than sufficient sleep group

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Good Sleep Practices - DO Go to bed at about the same time every night Arise at about the same time each morning Exercise early in the afternoon Develop a nightly sleep ritual (e.g. snack at bedtime) Make your bedroom dark, cool & quiet

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Poor Sleep Practices – DON T Drink caffeine in the afternoon Exercise within 3 hours of sleep Drink alcohol in the evening Smoke before sleep & during the night Use the bed for activities other than sleep & sex

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Behavioral Technique for Insomnia Stimulus control therapy To curtail sleep-incompatible behaviors & to regulate sleep-wake schedules Go to bed only when sleepy Bed & bedroom only for sleep and sex Get out of bed if unable to sleep for 15-20 min, & return only when sleepy again Arise in the morning at the same time Do not nap during the day Morin CM et al.1994.

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General Strategies for Solving Problems Rehearsal and planning sessions 20 minutes in early evening; in a quiet room. Reflect on the day past. Encourage yourself with achievements. Consider problem areas and loose ends. Reallocate time to deal with these. Consider any other matters e.g. emotional, financial.. Write down the first or next positive step of action to take and when you will take it. If when in bed new thoughts intrude refer them on to next day.

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Dealing with Frustration or Racing Thoughts Do not try too hard to fall asleep. State to yourself with sleep will come when it is ready, that relaxing in bed is almost as good. Try to keep your eyes open in the darkened room and as they (naturally) try to close tell yourself to resist that just for another few seconds. This procedure tempts sleep to take over. Try to ignore irrelevant ideas and thoughts. Visualize a pleasing scene or try repeating a semantically neutral word (such as the) subvocally every few seconds.

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